Is Physiotherapy Just The Placebo Effect?

As a Sports Therapists using Physiotherapy techniques I am often asked when I fix people “Is this just the placebo effect?” I find it ironic that it’s the people that are on the receiving end of the treatment that don’t know whether it’s placebo or not! After all it’s their brain that’s making them feel different. It does however raise an interesting larger debate – how much of physiotherapy techniques actually does anything and how much is just placebo. After 12 years of tinkering with people’s bodies and minds here’s what I’ve discovered…

What Is Placebo?

To use Google’s definition it is: “a medicine or procedure prescribed for the psychological benefit to the patient rather than for any physiological effect.” I like this definition. If you look at this Wikipedia definition however it comes across as a little bit more sinister in the realms of the con artist. So before I get in trouble with the Chartered Society of Physiotherapists and the Society of Sports Therapists lets go with the Google definition!

Is Placebo Used As An Explanation Too Often?

Yes! As a clinic that is proud to adopt an anything that works approach to treatment we’re often asked whether our treatment works just by the placebo affect. This is usually by doctors I meet at dinner parties! There then ensues a lively debate about randomised controlled trials and we end the evening agreeing to disagree. I can understand their point. If I try to explain how yesterday I fixed someone’s pelvis pain that had been there for 20 years by waggling their foot (it is more technical than that I promise!) then anyone would reasonably sceptical. The more you see it work, the less sceptical you become.

It’s very easy to dismiss things that we don’t understand and I feel that the placebo affect is often cited in medical circles to explain things that don’t exactly fit into current medical beliefs. In fairness I think that’s healthy. I don’t particularly want open heart surgery where the surgeon is just giving things a go! But by definition, this must have been the case at some point. Eeeek!

Is There Anything Wrong With The Placebo Effect?

Traditionally the placebo affect has had a bad wrap. Used by con-men and women to gain, usually financially, for not doing very much. However, with our new understanding of pain and the importance of psychology in pain as we discuss in this previous post I feel the term placebo affect needs to be abandoned and changed to something more fluffy and nice. How about “positive psychological effect management.” I’m pretty sure that one is not going stick so here’s a couple of example scenario for fictitious long standing knee pain:

Case 1 – Visit To Doctor’s Surgery

You arrive, the receptionist barely acknowledges you, and grunts at you and waves in the vague direction of a chair. You’re made to wait 20 minutes past your appointment before the doctor sees you. The doctor takes one look at the knee and tells you it’s your fault for doing too much, it’s ‘wear and tear’, there’s nothing can be done and it will never get better.

Case 2 – Visit To Brighton Sports Therapy (or other such injury clinic though why would you want to go anywhere else?!)

You’re greeted on arrival by one of our lovely therapists. They sit you down, make you a nice cup of tea (you have to bring your own biscuits!) and show a real interest in you and your condition. They take a full history of your condition and spend time to assess the knee and all other factors that can affect the knee. They explain how our treatment works and how it has improved many similar cases before and that they see no reason why you should be any different.

At this point – and we’ve still done no treatment – which case is going to be happier about the knee? Which case is going to feel more positive? I have in the past tested people conditions before and after talking people through their condition and what we’re going to do about it. You can reasonably consistently get a measurable improvement in symptoms just by talking to people. If you can make people feel more positive and reassured about the condition this changes the mapping of this part of their body in the brain and their symptoms change. It’s not a massive shift but it is perceptible.

Is this placebo? I don’t think so. This is the impact of a more positive happier mindset on the level of pain and discomfort we feel. This is basic pain psychology. Do we use this at the clinic? Hell yeah! Is it all of what we do? No. Just a small part in fact. But the sooner we can get people feeling positive about their condition the quicker we can fix them.

When we back this positive vibe up with some treatment that immediately makes the client feels less pain then we’re onto a winner.

Conversely in case one this may have had a nocebo affect. That is the doctor has done nothing to physiologically make the knee worse. However, chances are the knee will feel a hell of lot worse after such an encounter – we have seen many cases like this where a medical diagnosis has actually increased the person’s level of pain.

Conclusion

My belief is that “contextual factors” can play a role in determining the outcomes of clients from all kinds of physiotherapy techniques. But to say that all physiotherapy techniques work simply using placebo is far from the truth. For a start everyone’s perception is different.

I absolutely believe that clients outcomes are influenced by all kinds of factors. Do you like the therapist? Do you believe they know there stuff? Are the surroundings comfortable and of standard you would expect? A topic covered really nicely by the NOI Group here. However, these affects only go so far. Quite simply if a client feels a profound affect after the application of some treatment that will hugely outweigh the minimal impact of a purely placebo effect.

If you’d like to come in and try and judge for yourself whether our techniques are placebo, magic or somewhere in between we’d love to hear from you. Info@BrightonSportsTherapy.co.uk – .

Call us now 01273 921831

Dr Rank gives a medical perspective on the effectiveness of our treatments

Personal Trainer Kirsty - Knee Pain Gone

Dr Knight - Medical Doctor and Triathlete

Carol - Migraines

I have experienced some pain in the back of my knee. I have been to see Jamie and have to compliment his professional knowledge. He has the great ability to explain complex issues. He gave me lots of advise on how to treat my pain with everyday movements. Apart from his expertise, I would like to point out that Jamie is a very approachable and friendly person. I would highly recommend him!

CC

I picked up an IT band knee injury while training for the Brighton marathon this year that prevented me running any more than 5-10k without serious pain. I’d all but given up hope of running the marathon after trying various things to fix it without success. I started seeing Jamie less than 6 weeks before the marathon and after about 3-4 session I was able to run a lot further with much less pain. By the day of the marathon, my knee felt almost completely better, and I ran the whole thing with no knee pain at all! I don’t claim to fully understand everything Jamie does, but it definitely works. Amazing stuff & highly recommended!

BK

I compete in a lot of endurance sports and high impact sports too. I have seen Jamie for a few years now and he is among the very best I have seen (and I’ve seen a few over the years!) Highly recommended.

NL

Meeting Jamie for the first time was a very enjoyable experience, he explained a whole new way of the strains I had been putting on my body through Marathon running, tennis and bad posture, Within 30 mins he was working away and my body started to feel 10 years younger. A completely new and invigorating approach to back and muscles problems that I had battled with over the years.

Jamie is extremely good at getting fast results and you back on track with your exercise routines and he even sets you homework

I would have no hesitation of recommending BST to any one

AB

Jamie knows what he’s doing, though don’t expect traditional physiotherapy. I visited with a calf tear recovery problem after a recommendation by a friend. I couldn’t run without damaging it over and over again. Jamie’s holistic approach had me running again within the month, and I’m still running, building up distance again. While he was at it he’s helped massively with problems with my ankle and shoulder, definitely seek him out if you’re having problems.

SM

This guy knows his onions. After several Ironmans and too many marathons I was looking for someone to activate underused muscle groups and to help me feel less creaky overall. After sessions with BST I felt great and left with a whole new understanding of the human body. Jamie shared a lot of new and interesting insights and gave me a series of treatment that really worked.

SC

As an ultrarunner I approached Jamie Webb with much trepidation, expecting the usual advice to stop running silly distances and I wouldn’t be complaining of injuries. Instead, I was met with complete acceptance of ‘what I do’ combined with consistent ‘work’ on the source of my injuries/complaints. I couldn’t recommend Brighton Sports Therapy highly enough. It has been a joy to finally run pain-free again. My running complaints have ranged from ankle injuries to IT-band trouble, lazy glutes, core and hip stresses and strains … ALL of which I can happily say are currently in the best condition they can be in. Will I stop running? No. But the holistic approach of Brighton Sports Therapy has allowed me to continue, improve and race pain-free. Thank you.

AH

A few months ago as I began to have problems with my right knee, and on some occasions was unable to put weight on it when going up steps or uphill, I asked on Facebook if anyone knew of any good physiotherapists in my area, and I was recommended Jamie Webb. I went along and was assessed, with all aspects of my health taken into account, Jamie diagnosed a muscle imbalance, and immediately began working on releasing muscles in many parts of my body, but strangely (not to him) this had the effect of strengthening the muscles around my knee. I have since completed a 100k non stop walk, plus have trekked round Iceland with no further problems to my knee (or any other part of my poor body). I assure you that if Jamie is given a body suffering in any way from the traumas of sport, he will have you diagnosed, and be working on the problem within the first 30 minutes of your appointment, and you WILL leave after the 1st hour already aware of improvement.

DP

I can honestly say that’s the best money I’ve ever spent! I’d been struggling with a football injury for months and Jamie made a massive improvement in the first session. I’m now able to go into tackles 100% knowing that my ankle will be fine. I no longer need any more treatment, that’s how good things are, but if I do get another injury I know exactly who I’ll be ringing!

AP

Disclaimer: The testimonials above are the opinion of a few of our clients. Results to treatment cannot be guaranteed. We can guarantee we’ll be doing everything we can get you back to your best ASAP.